Concurrent chemoradiotherapy in locally and/or regionally advanced nasopharyngeal carcinoma

Abstract

The aim of the study was to investigate the efficacy of concurrent chemoradiotherapy (CCRT) in patients with locally and/or regionally advanced nasopharyngeal carcinoma (NPC). Between February 2005 and November 2007, 27 patients with advanced NPC were included in a prospective study of CCRT at the Radiotherapy and Oncology Institute in Skopje. Radiotherapy was performed using a sophisticated three-dimensional conformal technique. A dose of 69.4-71.4 Gy (median, 69.4 Gy) was delivered to the primary tumour and to the positive neck nodes. Chemotherapy consisted of cisplatin 30 mg/m(2) given concomitantly with radiation on a weekly basis. The median age was 49 years and 51.2% had stage IV disease. Eighty-eight percent received >or= 5 cycles of concurrent cisplatin. Complete response rates three months after chemoradiotherapy completion were 81.5% (22 of 27) and 91.3% (21 of 23) at the primary site and in the neck, respectively. Only one patient had a locoregional relapse and four patients developed distant metastases. The most prevalent grade 3 acute effect was mucositis present in 63.0% of patients. The 2-year disease-free survival (DFS) rate was 42.6%, the 2-year locoregional relapse-free survival (LR-RFS) rate was 76.9%, and the 2-year distant metastases relapse-free survival (DM-RFS) rate was 63.6%. Considering the preliminary results of our study which do not indicate that the therapeutic effects of CCRT evaluated are comparable with the results from the randomised phase III studies, we recommend an effort for the routine use of the new radiotherapy technique, intensity-modulated radiation therapy (IMRT), as well as an initiation of a phase III trial addressing the definition of the precise role of sequential chemotherapy in the management of patients with locally advanced NPC.